APA endorses Victorian Osteoarthritis Model of Care

Streamlining management and offering best-practice care for a chronic disease is the focus of the APA-endorsed Victorian Osteoarthritis Model of Care for knee and hip. An external expert advisory committee informed the Model of Care (MoC) and included five physiotherapists. Project leads were Carolyn Page, APA Musculoskeletal Physiotherapist, from St Vincent’s Hospital Melbourne, and Associate Professor Andrew Briggs, FACP, from the Victorian Musculoskeletal Clinical Leadership Group.

Despite osteoarthritis (OA) being a major burden on people who live with the disease and their communities, health services have not been consistently aligned to patient needs or with best evidence for effective care. Unlike acute health conditions, chronic diseases pose unique challenges for the health system, the MoC states. Consumers with chronic health conditions require more frequent and prolonged use of health resources, and often develop comorbidities, which often makes planning and delivery of care more complex and resource intensive. The MoC, says Carolyn, delivers an evidence- and consultation-informed framework that describes how health services and other resources should be delivered locally to those who live with the health condition.
‘The aim of the MoC is to provide a system-level, best-practice management framework for hip and knee osteoarthritis that is informed and supported by the health sector,’ Carolyn says. ‘It describes what the components of care should be and how these components of care should be delivered, such that the right care is delivered at the right time, by the right team, in the right place, with the right resources. It gives qualified health
professionals a framework for best-practice care and highlights the important role physiotherapists play in the diagnosis and management of osteoarthritis across the disease spectrum. This can include identifying suitable patients for surgery and there are recommendations within the MoC on surgical criteria that should be considered in this process.’

Unlike other chronic diseases such as diabetes, routine monitoring of signs and symptoms is not commonplace for OA, but is critical for delivering appropriate person-centred care, Carolyn says. The MoC summarises specific patient-reported and physical assessments for the OA population, and makes recommendations on minimum assessment to be made.

‘This is a role that physiotherapists can have significant involvement in,’ she says.

Inappropriate care, such as arthroscopic debridement for the management of osteoarthritis and the limited usefulness in magnetic resonance imaging, is outlined in the document. The MoC supports access to effective OA care through community health education, ensuring availability of services and the delivery of accurate information across the state to support effective self-care.

The MoC states that this needs to be done through many models, including improved access to allied health providers and strategies that support effective self-care, such as making sure people can access health facilities; ensuring best practice material is readily available to health providers and building workforce capability. Information and communication technologies are outlined as a key enabler of delivery of care, as telehealth and website services can provide wider and easier access to specialist and allied health professionals.

The Victorian MoC aligns to the Australian Commission on Safety and Quality in Health Care’s Clinical Care Standards for OA..

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